Indiana home care policies and procedures: what IDOH asks for

Unstable health conditions: referral notice

When the agency is aware a client's condition has become unstable or unpredictable, tell the client, representative, a family member or another person the client named that a medical referral is needed, and record the notice in the client record.

"If a personal services agency is aware that the client's medical or health condition has become unstable or unpredictable, the personal services agency shall notify the client, the client's personal representative, a family member, other relative of the client, or other person identified by the client of the need for a referral for medical or health services."

Unstable health conditions: documentation

The notice may be oral or written but is always documented in the client's record.

"The notification may be given in writing or orally and must be documented in the client's record with the personal services agency."

No managing medical conditions

The agency may continue personal services for a client with an unstable condition but may not manage the condition or present itself as able to.

"The personal services agency may continue to provide personal services for a client with an unstable or unpredictable medical or health condition but may not manage or represent itself as able to manage the client's medical or health condition."

Unstable health conditions policy with detailed procedure

IDOH asks for a policy and a detailed procedure, and its instruction letter asks for detail on the procedure in a medical emergency.

"Submit policy and procedure (provide detail procedure)"

Medical emergency procedure

Include what staff do in a medical emergency (IDOH guidance on the unstable conditions policy).

"Please provide detail on agency's unstable condition procedure in case of a medical emergency"

Client satisfaction review every 76 to 104 days

The manager or designee reviews services with each client every 76 to 104 days, in person or by phone, to decide whether the plan should change.

"The review with the client may be in person or by telephone."

Satisfaction review in writing, signed and dated

Each review is written and signed and dated by the person who conducted it.

"be signed and dated by the individual conducting the review"

Satisfaction review form

Submit the policy and the satisfaction review form with the application.

"Submit satisfaction review form"

What the satisfaction form must ask

Questions that measure satisfaction, the question "does the client require a change to his/her service plan?", and a place for the reviewer's signature and date.

"Ensure the question "does the client require a change to his/her service plan?" is included"

Investigate complaints

Investigate complaints from a client, family or representative about services furnished or not furnished, or about lack of respect for the client's property by anyone working for the agency.

"A personal services agency shall investigate a complaint made by a client, the client's family, or the client's personal representative regarding:"

Document complaints and resolutions

Record each complaint and how it was resolved.

"The personal services agency shall document the complaint and the resolution of the complaint."

Complaint policy with detailed procedures and complaint form

Submit a detailed complaint procedure and the complaint investigation form.

"Submit complaint investigation form"

What the complaint form must hold

Client name and date; signature and date of the person receiving the complaint; the complaint narrative; and the investigation, resolution and follow-up or corrective action.

"Include a place for the investigation, resolution, and follow-up/corrective action."

No reprisal for grievances

Clients may file grievances about services or lack of respect for property without discrimination or reprisal.

"is not subject to discrimination or reprisal for filing a grievance"

TB test for staff with direct client contact

Every employee or agent with direct client contact completes a TB test the way IDOH requires for home health agency staff.

"An employee or agent of a personal services agency who will have direct client contact must complete a tuberculosis test in the same manner as required by the state department for licensed home health agency employees and agents."

TB (control of communicable disease) policy

Submit a TB policy and procedure that follows 410 IAC 17-12-1.

"Complete a tuberculosis test in the same manner as required by the state department for license home health agency employees - refer to the 410 IAC 17-12-1."

Baseline two-step TB test

Baseline two-step Mantoux skin test (second step 1 to 3 weeks after the first) or a QuantiFERON test, unless a negative skin test is documented in the previous 12 months.

"The second step of a two-step tuberculin skin test using the Mantoux method must be administered one (1) to three (3) weeks after the first tuberculin skin test was administered."

Chest X-ray for TB history or a new positive

Anyone with a documented TB history, a previous positive result, completed TB treatment or a new positive skin test has one chest radiograph to exclude TB.

"must have one (1) chest radiograph to exclude a diagnosis of tuberculosis"

Annual TB screening

Screen every year after the baseline, with at least a Mantoux skin test or QuantiFERON test (except people under the chest X-ray route). IDOH's 2019 home health advisory allows a national standard instead; whether that applies to PSAs is an open question.

"include, at a minimum, a tuberculin skin test using the Mantoux method or a quantiferon-TB assay unless the individual was subject to subdivision (3)"

No work after a positive finding without physician approval

A person with a positive TB finding may not work or have direct client contact unless a physician approves them to work.

"Any person having a positive finding on a tuberculosis evaluation may not: (A) work in the home health agency; or (B) provide direct patient contact; unless approved by a physician to work."

TB documentation within 12 months

Keep documentation showing each worker with direct client contact had a negative TB finding within the previous 12 months.

"has had a negative finding on a tuberculosis examination within the previous twelve (12) months"

TB records kept as confidential medical files

Keep TB evaluations and follow-up in separate, confidential medical files. The rule binds home health agencies; IC 16-27-4-15 borrows only the TB test, so for a PSA this is recommended practice.

"must be maintained in separate medical files and treated as confidential medical records"

Document compliance and services

Keep evidence that the agency meets IC 16-27-4 and records of the services provided to clients.

"A personal services agency shall document evidence of compliance with the requirements of this chapter and document services provided to clients."

Keep records 7 years at an Indiana office

Keep the documentation, or electronic access to it, at the agency's Indiana office for at least 7 years.

"must be maintained or be electronically accessible at a personal services agency's office in Indiana for not less than seven (7) years"

Retention policy says when, where and how

The compliance documentation policy states the time frame and where and how records are stored.

"Include time frame, where and how records will be stored for record retention."

Produce documents for surveyors within 24 hours

Produce documents an IDOH surveyor requests within 24 hours (IDOH's reading of the statute's wording).

"A personal services agency must produce documents requested by the state department surveyor not less than twenty-four (24) hours after the documents have been requested."

Employ a manager

Employ a manager responsible for the organization and daily operation of the agency.

"A personal services agency shall employ an individual to act as the personal services agency's manager."

Manager's job description

Write a job description of the manager's day-to-day responsibilities (the 2022 letter also asks for a manager policy and procedure).

"Submit job description of the manager's day to day responsibilities of a personal services agency"

Written designation of the manager's designeesif the manager designates anyone to act for them

If the manager delegates (for example to an alternate manager or on-call staff), designate those people in writing.

"The manager may designate in writing one (1) or more individuals to act on behalf of or to perform any or all the responsibilities of the personal services agency's manager under this chapter."

24-hour telephone availability

The manager or a designee is available to respond to client phone calls 24 hours a day.

"shall be available to respond to client telephone calls twenty-four (24) hours a day"

Evaluate competency for each attendant care taskif the agency provides attendant care services

Evaluate each worker who will do attendant care for every attendant care task the agency has them perform.

"must be evaluated by the agency or the agency's designee for each attendant care services task that the personal services agency chooses to have that employee or agent perform"

Train on weak tasks and re-evaluateif the agency provides attendant care services

After an evaluation, train the worker on tasks needing improvement and re-evaluate after any training.

"After an evaluation, an employee or agent shall be trained in the attendant care services tasks the personal services agency believes require improvement. The employee or agent shall be reevaluated following any training."

Competent before working unsupervisedif the agency provides attendant care services

Complete the evaluation and competency decision before the worker performs the task for a client without direct agency supervision.

"The evaluation of the employee or agent and determination by the agency that the employee or agent is competent to perform the attendant care services task must occur before the employee or agent performs that task for a client without direct agency supervision."

Document evaluation and training

Record the content, date and evaluator's or trainer's signature for each worker who performs personal services, including lift services.

"The content of the evaluation and training conducted under this section, including the date and the signature of the person conducting the evaluation and training, must be documented for each employee or agent who performs personal services, including lift services."

Training policy answers IDOH's seven questions

How workers are evaluated and trained before serving clients; how they are re-evaluated and retrained; how skills demonstrations are observed; how competency is decided (pass mark); how unsupervised competence is assured; who trains and how training is signed and dated by trainer and employee; and what training is given.

"Who will conduct the employee training and ensure the training is documented with signature and date of individual conducting the training and employee receiving the training?"

Written competency test

Submit a copy of the written test.

"Submit a copy of the written test"

Demonstration and observation skills test

Submit a copy of the demonstration/observation skills test.

"Submit a copy of demonstration//observation skills test"

Training records in the employee file

Explain how retraining works and who trains, with trainer and employee signatures and dates, and place the training record in the employee's file.

"The training will be documented and placed in the employee's file."

Lift training, general and at the client's homeif the agency offers lift services

Train each worker who provides lift services on general lift standards and, at the client's home, on that client's lift per the manufacturer's instructions and manual; evaluate it like any attendant care task.

"A personal services agency that offers lift services to clients must train each employee or agent who provides those services on general standards for operating a lift"

Liability insurance covering lift servicesif the agency provides lift services

Hold a liability insurance policy that covers lift services.

"A personal services agency that provides lift services must have a liability insurance policy that covers lift services."

Client may decline any task, including lift useif the agency provides attendant care services

Respect a client's choice to decline any part of attendant care, including the lift; the client is never required to use lift equipment.

"Nothing in this chapter shall be construed to require a client to use lift equipment when lift services are provided."

Written service plan before services

The manager or designee prepares a written plan before services begin: dated and signed by the preparer, listing types and schedule of services, and stating the client's right to suspend, end or add services.

"state that the services to be provided to the client are subject to the client's right to temporarily suspend, permanently terminate, temporarily add, or permanently add the provision of any service"

Service plan contents

In writing, dated and signed by the preparer; lists the types and schedule of services.

"list the types and schedule of services to be provided"

Permanent changes in writing

Every permanent change to services needs a written change to the service plan.

"All permanent changes require a change in the written service plan."

Client signs within 14 days

Get the client's signature and date within 14 days after services begin and within 14 days after any permanent change.

"The service plan must be signed and dated by the client not later than fourteen (14) days after services begin for the client"

Service plan form and visit record form

Submit the service plan policy, the service plan form given to clients (services and days) and a visit record form.

"Submit visit record form"

What the service plan form must hold

Client name and date, start date, signatures and dates of client or representative and manager or designee, detailed services (such as bathing, dressing, transfers), the client's right to suspend, end or add services, and no medical language.

"Include detailed services provided (i.e., assistance with bathing, dressing/undressing, transfer)."

What the visit record must hold

Client name, dates of service, services provided, and signatures of the client and the employee.

"Include signature of client and employee."

No medical language

Keep medical language out of the policies, the service plan form and the visit record.

"Review to ensure no medical language is on the service plan form."

Written client rights statement within 7 days

Give the client or representative the agency's written statement of client rights no more than 7 days after services start.

"The personal services agency shall provide the client or the client's personal representative with the personal services agency's written statement of client rights not more than seven (7) days after providing services to the client."

Rights the statement must list

Property treated with respect; right to suspend, end or add services; right to file grievances without reprisal; freedom from verbal, physical and psychological abuse and treatment with dignity.

"The client has the right to be free from verbal, physical, and psychological abuse and to be treated with dignity."

Disclosures the statement must make

That managing unstable medical conditions is outside the license; the charges; the policy for notifying price increases; office hours; and that a list of 5% owners is available on request.

"The personal services agency's policy for notifying the client of any increase in the cost of services."

Contacts and complaint routes in the statement

How to reach the manager or designee when the office is open or closed; the agency complaint procedure and phone number; that IDOH does not inspect PSAs for licensing but investigates complaints; and IDOH's complaint procedure, phone number and business hours.

"The procedure and telephone number to call to file a complaint with the state department along with the business hours of the state department."

Client rights policy and statement

Submit the client rights policy and the statement the agency gives clients.

"Submit client rights statement that agency will provide to clients"

Rights form signed by client and manager

The client rights form is signed and dated by both the client and the agency's manager.

"Ensure the Clients rights form is signed and dated by both the Client and the agency's manager."

Non-discriminatory operational policies

Operational policies do not discriminate based on race, color, creed or national origin (certified on the application and renewal).

"I hereby certify that the operational policies of the agency will not discriminate based upon race, color, creed or national origin."

Renew the license every year

The license lasts one year; renew in the Gateway (it opens 60 days before expiry) and pay IDOH’s $250 renewal fee (from IDOH’s renewal form; the statute sets the fee for a license application).

"A license expires one (1) year after the date of issuance of the license under subsection (e)."

Disclose ownership and management

Disclose owners of 5% or more, officers, directors, managing agents and employees, the manager, and the CEO and governing body chair, at licensure, at each survey and on any change of management or of more than 5% of ownership.

"Disclosure of ownership and management information must be made to the state department:"

Report staff and agency changes to IDOH

Report changes of manager and other key staff with a background check, and address, contact, name and office-hours changes, through a manager, owner or designated party on file.

"This must be submitted by a manager, owner, or other designated party on file with IDOH."

Written notice 30 days before closing or selling

Notify IDOH in writing at least 30 days before closing or selling the agency.

"The licensee shall notify the state department in writing at least thirty (30) days before closing or selling the personal services agency."

New owner licensed before operatingif the agency is sold or transferred

After a sale, lease or other transfer, the new owner obtains its own license before operating the agency.

"the new owner or person in interest must obtain a license from the state department under this chapter before maintaining, operating, or conducting the personal services agency"

Branch office conditionsif the agency opens a branch office

Each branch provides services, is owned and controlled by the parent and is within 120 miles; IDOH wants the address and a map before adding it.

"owned and controlled by the parent personal services agency"

Out-of-state agenciesif the agency is based outside Indiana

An agency based in another state needs Secretary of State authorization and an Indiana branch office.

"A license is required for any personal services agency providing services in Indiana."

Policies named and ordered as IDOH asks

Name each policy by its statute heading, one policy per sheet with dividers, in the application's order, using the Secretary of State name; send only the policies IC 16-27-4 requires.

"Identify the name of each policy and insert a divider to separate each policy and documentation. Use the correct name of the policy, according to the Statute."

Owner, officer and manager checks

No owner or operator may have a disqualifying conviction; send a lifetime expanded or national check, dated within 3 months, for everyone the application’s ownership section lists (owners of 5% or more, and every owner, director, officer, partner, member, managing agent and managing employee), the manager and alternates, with the application and with any later change.

"An expanded or national criminal history check must be conducted on the owners, manager and alternate managers and included in the initial, change of ownership application and a staff change."

Apply for each caregiver's check within 3 business days

Apply for a national or expanded criminal history check no more than 3 business days after a caregiver starts working in clients' homes.

"may not employ a person to provide services in a patient's or client's temporary or permanent residence for more than three (3) business days without applying for a national criminal history background check or an expanded criminal history check"

Stop home visits at 21 days without a result

Do not keep a caregiver working in clients' homes more than 21 calendar days without the result, unless the State Police, FBI or vendor caused the delay.

"A home health agency or personal services agency may not employ a person to provide services in a patient's or client's temporary or permanent residence for more than twenty-one (21) calendar days without receipt of that person's national criminal history background check or expanded criminal history check"

Use a qualifying check

Use either an FBI fingerprint check plus a sex offender registry check, or a consumer reporting agency check covering every element IC 20-26-2-1.5 lists (IDOH also asks for a lifetime search).

"national criminal history background check (as defined in IC 10-13-3-12); and (B) check of: (i) sex offender registries in all fifty (50) states"

Do not employ disqualified caregivers

Do not employ anyone in clients' homes whose check shows a disqualifying conviction, or who has an abuse, neglect, mistreatment or misappropriation finding on the state nurse aide registry.

"may not employ a person to provide services in a patient's or client's temporary or permanent residence if one (1) or more of the following conditions exist"

Caregivers employed before July 1, 2025if the agency employed the caregiver before July 1, 2025

A caregiver employed before July 1, 2025 whose only bar is a recent misdemeanor theft or identity deception conviction may be kept on.

"has a misdemeanor conviction under subsection (a)(1)(D)(ii) or (a)(1)(E)(ii)"

Report employee convictions

Report an employee's conviction that indicates unfitness to the state nurse aide registry or the right licensing authority.

"If a home health agency or a personal services agency has knowledge of a conviction of an employee of the home health agency or personal services agency that would indicate unfitness for service as a home health aide, other unlicensed employee, or other health care professional"

Report endangered adults

Every staff member who believes or has reason to believe an adult is endangered must report.

"An individual who believes or has reason to believe that another individual is an endangered adult shall make a report under this chapter."

Staff notify the person in charge; own duty remains

Staff immediately notify the person in charge or their designee, who also becomes responsible to report; the staff member still reports unless a report has already been made.

"This section does not relieve an individual of the obligation to report on the individual's own behalf, unless a report has already been made to the best of the individual's belief."

Report to APS or law enforcement

Report suspected battery, neglect or exploitation of an endangered adult, or of a person of any age with a disability, to Adult Protective Services or law enforcement; knowingly failing to report is a Class B misdemeanor.

"believes or has reason to believe that an endangered adult or person of any age who has a mental or physical disability is the victim of battery, neglect, or exploitation"

No retaliation against reporters

Do not discharge, demote, transfer, give a negative evaluation or cut pay or benefits for a good-faith report.

"take any other action to retaliate against an employee who in good faith files a report under this chapter"

Report child abuse or neglect immediately

Any staff member with reason to believe a child is abused or neglected reports immediately to DCS or police, then tells the person in charge. Relevant to agencies serving families with children.

"an individual who has reason to believe that a child is a victim of child abuse or neglect shall make a report as required by this article"

Tell the person in charge after a child report

After reporting, the staff member notifies the person in charge or their designee that the report was made.

"shall notify the individual in charge of the institution, school, facility, organization, or agency or the designated agent of the individual in charge of the institution, school, facility, organization, or agency that the report was made"

No policy may restrict or delay child reports

The agency's reporting policy must not require staff to go through a manager first or otherwise delay a child abuse report.

"may not establish any policy that restricts or delays the duty of an employee or individual to report under this chapter"

Medication assistance limitsif the agency helps clients with medications

Set out what workers may do (reminders and cues, opening preset containers, help handling or taking medications when the client or a competent person directs it) and what they may not (anything needing a health care professional or an order). Good practice; the statute defines the task but sets no policy duty.

"competent and has directed the services"

Tasks that need a health care professional's order

List tasks workers must not do because they need a health care professional's order (outside personal services). Good practice; supports the unstable conditions and medical-language rules.

"Services that require the order of a health care professional for the services to be lawfully performed in Indiana."